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[Editorial] Alcohol and cancer

Sa, 18/11/2017 - 00:00
The Nov 7 publication of Alcohol and Cancer: a Statement of the American Society of Clinical Oncology (ASCO) emphasises the prominence of alcohol as a proven cause of many cancers. This view is not novel and comes exactly 30 years after a working group of the International Agency for Research on Cancer determined that alcoholic beverages were carcinogenic to humans. It has been echoed by other cancer societies since then but seemingly ignored by the wider medical community and by society. The influential endorsement by ASCO provides a powerful impetus to act on decades of evidence that alcohol harms health.

[Editorial] Does mobile health matter?

Sa, 18/11/2017 - 00:00
Widespread adoption of digital health applications (apps) in five patient populations (diabetes prevention, diabetes, asthma, cardiac rehabilitation, and pulmonary rehabilita-tion) could save the US health system $7 billion a year according to a report published by the IQVIA Institute for Human Data Science (formerly QuintilesIMS) on Nov 7. The report examines the impact of internet-connected mobile devices on human health and describes a doubling of health condition management mobile apps in the past 2 years.

[Editorial] Food industry must act to safeguard the future of antibiotics

Sa, 18/11/2017 - 00:00
WHO has urged farmers and the food industry to stop routine use of antibiotics in healthy animals to promote growth and prevent infectious diseases. WHO guidelines, which were released ahead of World Antibiotic Awareness Week (Nov 13–19), aim to tackle the growing threat of antimicrobial resistance to human health. Use of antibiotics promotes development of drug-resistant bacteria in food-producing animals, which can subsequently be transmitted to humans, and curbing use of antibiotics in animals can reduce the prevalence of resistant bacteria in animals and humans.

[Comment] Offline: WHO—a roadmap to renewal?

Sa, 18/11/2017 - 00:00
The honeymoon for WHO's new Director-General, Dr Tedros, is over. Now the serious work begins. At a special session of the agency's Executive Board next week, his proposed General Programme of Work (GPW) for 2019–23 will be tabled, debated, and judged for the first time. This document represents WHO's promise to the world. In many ways, it conveys urgency and ambition. The agency's mission is to promote health, keep the world safe, and serve the vulnerable. It will do so by achieving a “triple billion” target—1 billion more people with health coverage, 1 billion more people made safer, and 1 billion more people whose lives are improved.

[World Report] Towards introducing ACOs in the NHS

Sa, 18/11/2017 - 00:00
The UK Government is moving towards introducing Accountable Care Organisations to the NHS; some worry that this might happen without public consultation. Talha Burki reports.

[World Report] 2017 Prince Mahidol Award winners announced

Sa, 18/11/2017 - 00:00
Public health prize recognises scientists who advanced the field of Haemophilus influenzae type b vaccination, and medicine award goes to the Human Genome Project. Andrew Green reports.

[Perspectives] Picturing health: Rohingya refugees in Bangladesh

Sa, 18/11/2017 - 00:00
Since August, 2017, when violence broke out in Myanmar's northern Rahkine State, it is estimated that more than 600 000 Rohingya people have fled to Bangladesh. To accommodate the steady flow of people, vegetation on steep hillsides and between swathes of paddy fields in Bangladesh has been razed to build spontaneous settlements. Although Bangladesh is planning to build a camp that would house 800 000 people, Rohingya refugees are currently trying to survive in these crowded, haphazard camps. Humanitarian assistance is being provided by the Bangladesh Government, non-governmental organisations (NGOs), UN agencies, WHO, volunteers, and others, but conditions in the refugee camps are difficult.

[Correspondence] Charlottesville: blatant racism, not grievances, on display

Sa, 18/11/2017 - 00:00
We recently published a paper1 on structural racism in a Lancet Series on equity and equality in health in the USA. Structural racism refers to the many ways in which racial subjugation is embedded in US society—not just in one individual, or groups of individuals, or one institution, but in all of our institutions—from culture to housing to employment to law enforcement, and beyond.1,2 Racism is supported by wealthy and working class whites alike.2,3 The ultimate weapon to maintain and reproduce this system is terror.

[Correspondence] Bisphosphonates in osteoporosis: NICE and easy?

Sa, 18/11/2017 - 00:00
The recent National Institute for Health and Care Excellence (NICE) updated multiple technology appraisal on bisphosphonate use in osteoporosis1 demonstrates how, for a common disorder, the strict application of cost-effectiveness thresholds for inexpensive drugs might lead to counterintuitive and potentially harmful guidance. The multiple technology appraisal incorporates the development of fracture risk calculators based on individualised clinical risk factors, such as FRAX and QFracture (recommended by NICE for the assessment of fracture risk in some sections of the population2), and the availability of low-cost generic forms of oral and intravenous bisphosphonates.

[Correspondence] On evidence-based medicine

Sa, 18/11/2017 - 00:00
In their Review1 published in The Lancet (July 22, p 415), Benjamin Djulbegovic and Gordon H Guyatt provide a comprehensive overview of the challenges evidence-based medicine (EBM) will probably face in the next 25 years. Rightly, they conclude that it is a triumph that no critic of EBM has ever suggested that reliable evidence should not be key to medicine. EBM's next challenge will be the continued development of more efficient and rapid ways of disseminating evidence and guidelines.

[Correspondence] On evidence-based medicine

Sa, 18/11/2017 - 00:00
In the Review1 of evidence-based medicine by Benjamin Djulbegovic and Gordon H Guyatt, different or conflicting interpretation of the literature was not mentioned. Although such data selection might not be deliberate, it can be problematic and could result in different interpretations of the evidence by guidelines on the same topic.2

[Correspondence] On evidence-based medicine

Sa, 18/11/2017 - 00:00
In their Review,1 Benjamin Djulbegovic and Gordon H Guyatt do not adequately address the undue emphasis placed on randomisation in clinical research, which is arguably the main criticism of evidence-based medicine (EBM).

[Correspondence] On evidence-based medicine – Authors' reply

Sa, 18/11/2017 - 00:00
We thank Marjolein A van der Marck and colleagues, Feras Ali Mustafa, and Jan Matthys for their interest in our Review.1 We agree with van der Marck and colleagues that tackling multimorbidity is an enormous challenge for evidence-based practice that, so far, has not been met. Authors within the evidence-based medicine (EBM) community have, however, suggested initial strategies for those who write guidelines2 and for the broader scientific community,3 and have emphasised the need for approaches that are minimally disruptive to patients' lives.

[Correspondence] Practical applications of evolutionary biology in public health

Sa, 18/11/2017 - 00:00
Jonathan Wells and colleagues,1 Grazyna Jasienska and colleagues,2 and Graham Rook and colleagues3 are to be congratulated on producing a fascinating and thought-provoking Series on how evolutionary biology could contribute to public health. The key insight that our goal in life might be reproductive success, rather than longevity, provides a means to re-conceptualise public health and could inform some of the major conundrums in global public health.

[Editorial] Eliminating viral hepatitis: time to match visions with action

Sa, 11/11/2017 - 00:00
Viral hepatitis caused an estimated 1·4 million deaths in 2015—similar to tuberculosis and more than either HIV or malaria, yet historically these diseases have received insufficient attention from donors and policy makers. In May, 2016, the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis, 2016–20, which aims to eliminate viral hepatitis as a major public health threat by 2030. The strategy set global targets to reduce new viral hepatitis infections by 90% and to reduce deaths due to viral hepatitis by 65%, focusing mainly on hepatitis B virus (HBV) and hepatitis C virus (HCV), which are responsible for most of the global burden.

[Editorial] Eliminating viral hepatitis: time to match visions with action

Sa, 11/11/2017 - 00:00
Viral hepatitis caused an estimated 1·4 million deaths in 2015—similar to tuberculosis and more than either HIV or malaria, yet historically these diseases have received insufficient attention from donors and policy makers. In May, 2016, the World Health Assembly adopted the Global Health Sector Strategy on Viral Hepatitis, 2016–20, which aims to eliminate viral hepatitis as a major public health threat by 2030. The strategy set global targets to reduce new viral hepatitis infections by 90% and to reduce deaths due to viral hepatitis by 65%, focusing mainly on hepatitis B virus (HBV) and hepatitis C virus (HCV), which are responsible for most of the global burden.

[Editorial] The case for action on childhood pneumonia

Sa, 11/11/2017 - 00:00
Pneumonia kills almost 1 million children each year, and more than 80% of these deaths are children under 2 years of age. While not solely a disease of developing countries—it is the leading cause of child hospitalisation in the USA—it disproportionately affects children living with poverty or malnourishment who are the most vulnerable to infection. A key defence is immunisation, but over 25 million children under 2 years were not immunised with the pneumococcal conjugate vaccine in 2016. Available vaccines are produced by just two manufacturers and priced out of the reach of many countries, even with assistance from Gavi, which has immunised 109 million children against pneumococcal disease as of last year.

[Editorial] The case for action on childhood pneumonia

Sa, 11/11/2017 - 00:00
Pneumonia kills almost 1 million children each year, and more than 80% of these deaths are children under 2 years of age. While not solely a disease of developing countries—it is the leading cause of child hospitalisation in the USA—it disproportionately affects children living with poverty or malnourishment who are the most vulnerable to infection. A key defence is immunisation, but over 25 million children under 2 years were not immunised with the pneumococcal conjugate vaccine in 2016. Available vaccines are produced by just two manufacturers and priced out of the reach of many countries, even with assistance from Gavi, which has immunised 109 million children against pneumococcal disease as of last year.

[Editorial] Support for a publicly funded health system in the USA

Sa, 11/11/2017 - 00:00
On Nov 8, a high-level panel—Health for All: #Walktogether—was held in New York City, NY, USA. It brought together two Elders—former Secretary General of the UN Ban Ki-moon and former Director General of WHO Gro Harlem Brundtland—and local health activists and politicians to discuss the need for publicly funded health systems in order for governments to deliver universal health coverage (UHC) by 2030. This event was held as part of a global tour that marks the tenth anniversary of the founding of The Elders, an independent group that provides leadership on the most pressing issues facing humanity.

[Comment] Hidden conflicts of interest in continuing medical education

Sa, 11/11/2017 - 00:00
Continuing medical education (CME) is an integral part of postgraduate training for medical professionals in the USA and globally. CME enables physicians to maintain and gain knowledge and skills that ensure optimal medical care and outcomes for patients. For these reasons CME is a required component of licensure in the USA.1,2 Since most physicians regularly complete CME hours, conflicts of interest that could introduce bias into CME must be avoided to prevent potentially detrimental downstream effects on patient care.